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Schmidt F, Azar C, Goektas O. Treatment of Olfactory Disorders After SARS - CoViD 2 Virus Infection. EAR, NOSE & THROAT JOURNAL 2024; 103:48S-53S. [PMID: 36976171 PMCID: PMC10051008 DOI: 10.1177/01455613231168487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/21/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE The benefit of a nasal corticosteroid in the treatment of persistent post-infectious smell disorders is not as clear in previous studies as is assumed for olfactory training. This study would therefore like to describe the treatment strategies using the example of a persistent olfactory dysfunction as a result of a proven infection with SARS-CoViD-2-virus. METHODS Twenty patients (average age of 33.9 ± 11.9 years) with hyposmia were included in this study from December 2020 to July 2021. Every second patient received additionally a nasal corticosteroid. The two resulting randomized groups of equal size were screened with the TDI test, a 20-item taste powder test for the assessment of retronasal olfaction and otorhinolaryngological examination. The patients were asked to train twice daily using a standardized odor training kit and followed up after 2 months and 3 months, respectively. RESULTS We documented a significant overall improvement in olfactory ability over the investigation period in both groups. While the TDI score steadily increased on average under the combination therapy, the rise under olfactory training alone was initially steeper. This short-term interaction effect over mean two months was not statistically significant. According to Cohen, however, a moderate effect (eta2 = 0.055, Cohen`s d = 0.5) can still be assumed. This effect could be explained by a possibly higher compliance at the beginning of the sole olfactory training due to the lack of further drug treatment offers. When the training intensity decreases, the recovery of the sense of smell stagnates. Adjunctive therapy ultimately outweighs this short-term benefit. CONCLUSIONS The results reinforce the recommendation of early and consistent olfactory training on patients with dysosmia due to COVID-19. For continuous improvement of the sense of smell, an accompanying topical treatment seems at least to be worth consideration. The results should be optimized with larger cohorts and using new objective olfactometric methods.
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Affiliation(s)
- F. Schmidt
- Departement of ENT Practice, ENT Center, HNO Zentrum am Kudamm, Berlin, Germany
| | - C. Azar
- Departement of ENT Practice, ENT Center, HNO Zentrum am Kudamm, Berlin, Germany
| | - O. Goektas
- Departement of ENT Practice, ENT Center, HNO Zentrum am Kudamm, Berlin, Germany
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Vaira LA, Boscolo-Rizzo P, Lechien JR, Mayo-Yáñez M, Petrocelli M, Pistidda L, Salzano G, Maglitto F, Hopkins C, De Riu G. Olfactory recovery following omicron variant infection: a psychophysical prospective case-control study with six-month follow up. J Laryngol Otol 2023; 137:1395-1400. [PMID: 37194489 DOI: 10.1017/s0022215123000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study aimed to evaluate the recovery of olfactory function at six months in individuals infected with the coronavirus disease 2019 omicron variant, using psychophysical tests. METHODS A prospective case-control study that included severe acute respiratory syndrome coronavirus-2 patients infected in February and March 2022 was conducted. Patients underwent the Sniffin' Sticks test within 10 days of infection and again after at least 6 months. The olfactory scores were compared with those of a control group. RESULTS In all, 102 patients and 120 controls were enrolled in the study. At baseline, 26 patients (25.5 per cent) self-reported smell loss. The median threshold, discrimination and identification score was 33.6 (interquartile range, 12.5) for the cases and 36.5 (interquartile range, 4.38) for the controls (p < 0.001). Based on the threshold, discrimination and identification scores, 12 controls and 34 patients reported olfactory dysfunction (p < 0.001). Eighty cases underwent re-evaluation at six months; the median threshold, discrimination and identification score was 37.1 (interquartile range, 4.75) with no significant differences compared with the controls. CONCLUSION Six months after infection, the prevalence of olfactory dysfunction in patients did not differ significantly from the control population.
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Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Biomedical Science Department, School of Biomedical Science, University of Sassari, Sassari, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Jerome R Lechien
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otolaryngology - Head Neck Surgery, Elsan Polyclinic of Poitiers, Poitiers, France
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Complex of A Coruña ('CHUAC'), A Coruña, Spain
| | - Marzia Petrocelli
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Maxillofacial Surgery Unit, Bellaria-Maggiore Hospital, Azienda Unità Sanitaria Locale della ('AUSL') Bologna, Bologna, Italy
| | - Laura Pistidda
- Intensive Care Unit Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giovanni Salzano
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Department of Maxillofacial Surgery, University of Naples 'Federico II', Naples, Italy
| | - Fabio Maglitto
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Department of Maxillofacial Surgery, University of Naples 'Federico II', Naples, Italy
| | - Claire Hopkins
- Rhinology, King's College, London, UK
- British Rhinological Society, London, UK
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
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Hintschich CA, Wege-Lüssen A, Göktas Ö, Stuck BA, Müller CA, Hummel T. [Persistent olfactory impairment after COVID-19-recommendations of the Working Group on Olfactology and Gustology of the German Society of Oto-rhino-laryngology, Head and Neck Surgery]. HNO 2023; 71:739-743. [PMID: 37801102 PMCID: PMC10589143 DOI: 10.1007/s00106-023-01368-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/07/2023]
Abstract
This article does not intend to comprehensively review the existing literature on coronavirus disease 2019 (COVID-19)-associated smell disorders, but aims to summarize scientific evidence for otorhinolaryngological practice and provide recommendations for diagnosis and treatment of persistent smell disorders following COVID-19.
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Affiliation(s)
- Constantin A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | | | | | - Boris A Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Christian A Müller
- Universitätsklinik für Hals‑, Nasen- und Ohrenkrankheiten, Kopf- und Halschirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Thomas Hummel
- Interdisziplinäres Zentrum für Riechen und Schmecken, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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Hummel T, Power Guerra N, Gunder N, Hähner A, Menzel S. Olfactory Function and Olfactory Disorders. Laryngorhinootologie 2023; 102:S67-S92. [PMID: 37130532 PMCID: PMC10184680 DOI: 10.1055/a-1957-3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The sense of smell is important. This became especially clear to patients with infection-related olfactory loss during the SARS-CoV-2 pandemic. We react, for example, to the body odors of other humans. The sense of smell warns us of danger, and it allows us to perceive flavors when eating and drinking. In essence, this means quality of life. Therefore, anosmia must be taken seriously. Although olfactory receptor neurons are characterized by regenerative capacity, anosmia is relatively common with about 5 % of anosmic people in the general population. Olfactory disorders are classified according to their causes (e. g., infections of the upper respiratory tract, traumatic brain injury, chronic rhinosinusitis, age) with the resulting different therapeutic options and prognoses. Thorough history taking is therefore important. A wide variety of tools are available for diagnosis, ranging from short screening tests and detailed multidimensional test procedures to electrophysiological and imaging methods. Thus, quantitative olfactory disorders are easily assessable and traceable. For qualitative olfactory disorders such as parosmia, however, no objectifying diagnostic procedures are currently available. Therapeutic options for olfactory disorders are limited. Nevertheless, there are effective options consisting of olfactory training as well as various additive drug therapies. The consultation and the competent discussion with the patients are of major importance.
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Affiliation(s)
- T Hummel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - N Power Guerra
- Rudolf-Zenker-Institut für Experimentelle Chirurgie, Medizinische Universität Rostock, Rostock
| | - N Gunder
- Universitäts-HNO Klinik Dresden, Dresden
| | - A Hähner
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - S Menzel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
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Lechien JR, Wajsblat S, Horoi M, Boscolo-Rizzo P, Le Bon SD, Vaira LA, Saussez S. Comparison of prevalence and evolution of COVID-19 olfactory disorders in patients infected by D614 (wild) and B.1.1.7. Alpha variant: a brief report. Eur Arch Otorhinolaryngol 2023; 280:3461-3467. [PMID: 36943439 PMCID: PMC10029791 DOI: 10.1007/s00405-023-07923-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/11/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES To investigate the prevalence and the evolution of olfactory disorders (OD) related to coronavirus disease 2019 (COVID-19) in patients infected during the first and the second European waves. METHODS From March 2020 to October 2020, COVID-19 patients with OD were recruited and followed over the 12-month post-infection. The following data were collected: demographic, treatments, vaccination status, and olfactory function. Olfaction was assessed with the Olfactory Disorder Questionnaire (ODQ), and threshold, discrimination, and identification (TDI) test. Outcomes were compared between patients of the first wave (group 1: wild/D614G virus) and the second wave (group 2: B.1.1.7. Alpha variant) at 1-, 3- and 12-month post-infection. RESULTS Sixty patients completed the evaluations accounting for 33 and 27 patients in group 1 and 2, respectively. The 1-month TDI score (23.7 ± 5.3) was significantly lower in group 2 compared to group 1 (29.8 ± 8.7; p = 0.017). Proportion of normosmic patients at 1-month post-infection was significantly higher in group 1 compared to group 2 (p = 0.009). TDI scores only significantly increased from 1- to 3-month post-infection in anosmic and hyposmic patients. Focusing on There was a negative association between the 1-month ODQ and the 1-month TDI (rs = - 0.493; p = 0.012). ODQ was a significant predictor of TDI scores at 3- and 12-month post-infection. The 12-month prevalence of parosmia was 60.6% in group 1 and 42.4% in group 2, respectively. There was no significant influence of oral corticosteroid treatment, adherence to an olfactory training and vaccination status on the olfactory outcomes. CONCLUSIONS Patients of the second wave (Alpha B.1.1.7. variant) reported significant higher proportion of psychophysical test abnormalities at 1-month post-infection than patients infected during the first wave (D614G virus).
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, Polyclinic of Poitiers, Elsan, Poitiers, France.
- Division of Laryngology and, Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Foch Hospital, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Shannon Wajsblat
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
| | - Mihaela Horoi
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Serge D Le Bon
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Genève, Geneva, Suisse
| | - Luigi A Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100, Sassari, Italy
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100, Sassari, Italy
| | - Sven Saussez
- Division of Laryngology and, Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
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Schirinzi T, Lattanzi R, Maftei D, Grillo P, Zenuni H, Boffa L, Albanese M, Simonetta C, Bovenzi R, Maurizi R, Loccisano L, Vincenzi M, Greco A, Di Girolamo S, Mercuri NB, Passali FM, Severini C. Substance P and Prokineticin-2 are overexpressed in olfactory neurons and play differential roles in persons with persistent post-COVID-19 olfactory dysfunction. Brain Behav Immun 2023; 108:302-308. [PMID: 36549578 PMCID: PMC9760596 DOI: 10.1016/j.bbi.2022.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Persistent olfactory dysfunction (OD) is one of the most complaining and worrying complications of long COVID-19 because of the potential long-term neurological consequences. While causes of OD in the acute phases of the SARS-CoV-2 infection have been figured out, reasons for persistent OD are still unclear. Here we investigated the activity of two inflammatory pathways tightly linked with olfaction pathophysiology, namely Substance P (SP) and Prokineticin-2 (PK2), directly within the olfactory neurons (ONs) of patients to understand mechanisms of persistent post-COVID-19 OD. ONs were collected by non-invasive brushing from ten patients with persistent post-COVID-19 OD and ten healthy controls. Gene expression levels of SP, Neurokinin receptor 1, Interleukin-1β (IL-1β), PK2, PK2 receptors type 1 and 2, and Prokineticin-2-long peptide were measured in ONs by Real Time-PCR in both the groups, and correlated with residual olfaction. Immunofluorescence staining was also performed to quantify SP and PK2 proteins. OD patients, compared to controls, exhibited increased levels of both SP and PK2 in ONs, the latter proportional to residual olfaction. This work provided unprecedented, preliminary evidence that both SP and PK2 pathways may have a role in persistent post-COVID-19 OD. Namely, if the sustained activation of SP, lasting months after infection's resolution, might foster chronic inflammation and contribute to hyposmia, the PK2 expression could instead support the smell recovery.
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Affiliation(s)
- Tommaso Schirinzi
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Italy.
| | - Roberta Lattanzi
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy
| | - Daniela Maftei
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy
| | - Piergiorgio Grillo
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Henri Zenuni
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Laura Boffa
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Maria Albanese
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Clara Simonetta
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Roberta Bovenzi
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Riccardo Maurizi
- Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Italy
| | - Laura Loccisano
- Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Italy
| | - Martina Vincenzi
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Stefano Di Girolamo
- Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Italy
| | - Nicola B. Mercuri
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Francesco M. Passali
- Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Italy
| | - Cinzia Severini
- Department of Biochemistry and Cell Biology, National Research Council of Italy, Rome, Italy
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7
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Vaira LA, Lechien JR, Deiana G, Salzano G, Maglitto F, Piombino P, Mazzatenta A, Boscolo-Rizzo P, Hopkins C, De Riu G. Prevalence of olfactory dysfunction in D614G, alpha, delta and omicron waves: a psychophysical case-control study. Rhinology 2023; 61:32-38. [PMID: 36272169 DOI: 10.4193/rhin22.294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to compare the prevalence of olfactory dysfunction (OD) at different stages of the COVID-19 pandemic by evaluating subjects diagnosed with SARS-CoV-2 infection during the Omicron wave with psychophysical tests and comparing the results with those obtained from patients infected during the D614G, Alpha and Delta waves and with those of a control group. METHODOLOGY The study included adult patients diagnosed with SARS-CoV-2 infection. Depending on the time of diagnosis, the subjects were divided into four study groups: D614G; Alpha, Delta and Omicron variant groups. A group of uninfected individuals was used as control. All subjects underwent psychophysical evaluation of the olfactory function with the Connecticut Chemosensory Clinical Research Center olfactory test (D614G and Alpha groups) or the extended version of the Sniffin'Sticks test (Delta, Omicron and control groups). RESULTS 372 cases (134 D614G group, 118 Alpha group, 32 in Delta group and 88 Omicron group) were recruited and evaluated within 10 days of infection, alongside 80 controls. Patients self-reported olfactory loss in 72.4% of cases in the D614G group, in 75.4% of cases in the Alpha group, in 65.6% of cases in the Delta group and in 18.1% in the Omicron group. Psychophysical evaluation revealed a prevalence of OD: 80.6%, 83.0%, 65.6% and 36.3% in the D614G, Alpha, Delta and Omicron group respectively. The differences between the D614G, Alpha and Delta groups were not statistically significant. The Omicron group demonstrated a significantly lower prevalence of OD than the other variants but still significantly higher than the controls. CONCLUSIONS During the Omicron wave OD was less prevalent than during the D614G, Alpha and Delta periods. One-third of patients have reduced olfactory function on psychophysical evaluation during the Omicron wave. Our results should be considered with caution as the VOC has not been determined with certainty.
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Affiliation(s)
- L A Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy
| | - J R Lechien
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS. Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head Neck Surgery, Elsan Hospital, Paris, France
| | - G Deiana
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy
| | - G Salzano
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; Department of Maxillofacial Surgery, University of Naples Federico II, Naples, Italy
| | - F Maglitto
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; Department of Maxillofacial Surgery, University of Naples Federico II, Naples, Italy
| | - P Piombino
- Department of Maxillofacial Surgery, University of Naples Federico II, Naples, Italy
| | - A Mazzatenta
- Neurophysiology, Olfaction and Chemoreception Laboratory, Physiology and Physiopathology Section, Neuroscience, Imaging and Clinical Sciences Department, G. d Annunzio, University of Chieti-Pescara, Chieti Scalo, Italy
| | - P Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - C Hopkins
- King's College, London, UK; British Rhinological Society (President), London, UK
| | - G De Riu
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Chee J, Chern B, Loh WS, Mullol J, Wang DY. Pathophysiology of SARS-CoV-2 Infection of Nasal Respiratory and Olfactory Epithelia and Its Clinical Impact. Curr Allergy Asthma Rep 2023; 23:121-131. [PMID: 36598732 PMCID: PMC9811886 DOI: 10.1007/s11882-022-01059-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW While the predominant cause for morbidity and mortality with SARS-CoV-2 infection is the lower respiratory tract manifestations of the disease, the effects of SARS-CoV-2 infection on the sinonasal tract have also come to the forefront especially with the increased recognition of olfactory symptom. This review presents a comprehensive summary of the mechanisms of action of the SARS-CoV-2 virus, sinonasal pathophysiology of COVID-19, and the correlation with the clinical and epidemiological impact on olfactory dysfunction. RECENT FINDINGS ACE2 and TMPRSS2 receptors are key players in the mechanism of infection of SARS-CoV-2. They are present within both the nasal respiratory as well as olfactory epithelia. There are however differences in susceptibility between different groups of individuals, as well as between the different SARS-CoV-2 variants. The sinonasal cavity is an important route for SARS-CoV-2 infection. While the mechanism of infection of SARS-CoV-2 in nasal respiratory and olfactory epithelia is similar, there exist small but significant differences in the susceptibility of these epithelia and consequently clinical manifestations of the disease. Understanding the differences and nuances in sinonasal pathophysiology in COVID-19 would allow the clinician to predict and counsel patients suffering from COVID-19. Future research into molecular pathways and cytokine responses at different stages of infection and different variants of SARS-CoV-2 would evaluate the individual clinical phenotype, prognosis, and possibly response to vaccines and therapeutics.
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Affiliation(s)
- Jeremy Chee
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Beverlyn Chern
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Woei Shyang Loh
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore ,grid.4280.e0000 0001 2180 6431Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joaquim Mullol
- grid.10403.360000000091771775Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Catalonia Spain
| | - De Yun Wang
- Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Desai DD, Yu SE, Salvatore B, Goldberg Z, Bowers EMR, Moore JA, Phan B, Lee SE. Olfactory and neurological outcomes of SARS-CoV-2 from acute infection to recovery. FRONTIERS IN ALLERGY 2022; 3:1019274. [DOI: 10.3389/falgy.2022.1019274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Educational objectiveTo investigate the impact of SARS-CoV-2 on sinonasal quality of life, olfaction, and cognition at different stages of viral infection and evaluate the association between olfaction and cognition in this population cohort.ObjectivesWhile olfactory dysfunction (OD) is a frequently reported symptom of COVID-19 (98% prevalence), neurocognitive symptoms are becoming more apparent as patients recover from infection. This study aims to address how different stages of infection [active infection (positive PCR test, symptomatic) vs. recovered (7 days post-symptoms)] compared to healthy control patients influence sinonasal quality of life, olfactory function, and cognition.Study designProspective, longitudinal, case-control.MethodsParticipants completed the SNOT-22, University of Pennsylvania Smell Identification Test (UPSIT) and validated cognitive examinations to assess degree of smell loss and neurocognitive function at baseline and at 1 and 3 months for the active group and 3 months for the recovered group. Self-reported olfactory function and overall health metrics were also collected.ResultsThe recovered group had the lowest average UPSIT score of 27.6 compared to 32.7 (active) and 32.6 (healthy control). 80% (n = 24) of the recovered patients and 56.3% (n = 9) of the active patients suffered from smell loss. In follow-up, the active group showed improvement in UPSIT scores while the recovered group scores worsened. In terms of neurocognitive performance, recovered patients had lower processing speed despite an improving UPSIT score.ConclusionSARS-CoV-2 infection was found to impact olfactory function in a delayed fashion with significant impact despite recovery from active infection. Although olfactory function improved, decrements in cognitive processing speed were detected in our cohort.
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Hintschich CA, Dietz M, Haehner A, Hummel T. Topical Administration of Mometasone Is Not Helpful in Post-COVID-19 Olfactory Dysfunction. Life (Basel) 2022; 12:life12101483. [PMID: 36294918 PMCID: PMC9605508 DOI: 10.3390/life12101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
Persistent olfactory dysfunction is a major concern post-COVID-19, affecting up to 5% of all patients. Different therapeutic options, including mometasone nasal spray, have been recommended, only some of which have been validated for post-COVID-19 olfactory dysfunction. In this study we psychophysically assessed the effect of intranasally applied mometasone furoate on the recovery of olfaction. The spray was applied with a long applicator so that the olfactory cleft could be reached effectively. After olfactory dysfunction had been confirmed psychophysically using Sniffin’ Sticks, patients were randomly assigned to two different treatment arms: the study group (n = 40) underwent olfactory training and intranasal administration of mometasone furoate twice daily, whereas the control group (n = 46) performed olfactory training only. After a study duration of three months, psychophysical testing of olfaction was repeated using Sniffin’ Sticks. We found no benefit of an additional topical administration of mometasone furoate compared to olfactory training alone. These results psychophysically confirm two previous studies which were based on patients’ subjective self-ratings. Our findings are in contrast to current recommendations for the management of olfactory dysfunction post-COVID-19, which might have to be adapted accordingly.
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Affiliation(s)
- Constantin A. Hintschich
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, 01307 Dresden, Germany
- Department of Otorhinolaryngology, Regensburg University Hospital, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-941-944-9401
| | - Melanie Dietz
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, 01307 Dresden, Germany
| | - Antje Haehner
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, 01307 Dresden, Germany
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, 01307 Dresden, Germany
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Hintschich CA, Vielsmeier V, Bohr C, Hagemann J, Klimek L. Author's reply to the Letter to the Editor "The study of olfactory dysfunction in SARS-CoV-2 variants". Eur Arch Otorhinolaryngol 2022; 279:5471-5472. [PMID: 35904630 PMCID: PMC9335000 DOI: 10.1007/s00405-022-07569-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Constantin A Hintschich
- Department of Otorhinolaryngology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christopher Bohr
- Department of Otorhinolaryngology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Jan Hagemann
- Department of Otorhinolaryngology, Mainz University Hospital, Mainz, Germany
| | - Ludger Klimek
- Department of Otorhinolaryngology, Mainz University Hospital, Mainz, Germany
- Center for Rhinology and Allergology, Wiesbaden, Germany
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Vaira LA, Boscolo-Rizzo P, Bui Quoc E, Bandekela P, Saussez S, Lechien JR. The study of olfactory dysfunction in SARS-CoV-2 variants. Eur Arch Otorhinolaryngol 2022; 279:5469-5470. [PMID: 35841408 PMCID: PMC9287686 DOI: 10.1007/s00405-022-07548-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Luigi A Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy
| | - Paolo Boscolo-Rizzo
- Section of Otolaryngology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Emily Bui Quoc
- Department of Anesthesiology, EpiCURA Hospital, Baudour, Belgium
| | | | - Sven Saussez
- Division of Laryngology and Bronchoesophagology, EpiCURA Hospital, University of Mons, Baudour, Avenue du Champ de Mars, 6, 7000, Mons, Belgium
| | - Jerome R Lechien
- Department of Otolaryngology, Elsan Polyclinic of Poitiers, Poitiers, France. .,Department of Otolaryngology-Head Neck Surgery, School of Medicine, Foch Hospital, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France. .,Division of Laryngology and Bronchoesophagology, EpiCURA Hospital, University of Mons, Baudour, Avenue du Champ de Mars, 6, 7000, Mons, Belgium.
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